title: Reduced incidence of second solid tumors in survivors of childhood Hodgkin's lymphoma treated without radiation therapy.
abstract: BACKGROUND
  We assessed the risk of developing second malignancies in children treated for Hodgkin's lymphoma (HL), the majority of whom received chemotherapy only.
  
  
  METHODS
  The development of second malignancies in children with HL, treated between 1960 and 1999, was assessed. Results were obtained by both chart review and linkage with a centralized cancer registry. Tumor incidence was compared for patients treated with and without radiotherapy (RT) and with the general population. Risk factors for developing second tumors were assessed by multivariate analysis.
  
  
  RESULTS
  Of 142 childhood HL patients, 63 had received RT and 79 had not. Overall survival was similar for both groups. Fourteen patients developed second solid tumors, 12 who had received RT and 2 treated with chemotherapy only (P <0.001), with a 30-year cumulative incidence of 24.7% [95% confidence interval (CI) 7.27-47.4] and 5.8% (95% CI 0-58.9), respectively (P = 0.01). The standardized incidence ratio for second solid tumors was 236 (95% CI 112.2-359.0) versus 43.6 (95% CI 0-103.9), respectively. Multivariate analysis showed treatment with RT was the only significant risks factor for developing second solid tumors.
  
  
  CONCLUSIONS
  Children with HL without RT have a substantially lower incidence of second tumors than those treated with RT.
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick.
authors.forename: P M
authors.initials: PM
authors.lastname: Barbaro
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick.
authors.forename: K
authors.initials: K
authors.lastname: Johnston
authors.affiliation: Department of Oncology, The Children's Hospital, Westmead.
authors.forename: L
authors.initials: L
authors.lastname: Dalla-Pozza
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Cohn
authors.affiliation: School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia.
authors.forename: Y A
authors.initials: YA
authors.lastname: Wang
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia.
authors.forename: G M
authors.initials: GM
authors.lastname: Marshall
authors.affiliation: Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia. Electronic address: d.ziegler@unsw.edu.au.
authors.forename: D S
authors.initials: DS
authors.lastname: Ziegler
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult